Permit 4 CITYOFTIGARD ELECTRICAL PERMIT -
RESTRICTED ENERGY
��Ii DEVELOPMENT H BMEN 1639 -4171 DATE PERMIT #: ISSUED: 9/15/2004
SITE ADDRESS: 09635 SW PIHAS ST PARCEL: 1S135CD -13200
SUBDIVISION: GREENBURG PINES ZONING: R -4.5
BLOCK: LOT: 003 JURISDICTION: TIG
Project Description: ALL ENCOMPASSING LOW VOLTAGE.
A. RESIDENTIAL B. COMMERCIAL
AUDIO & STEREO: X AUDIO & STEREO: INTERCOM & PAGING:
BURGLAR ALARM: X BOILER: LANDSCAPE /IRRIGAT:
GARAGE OPENER: X CLOCK: MEDICAL:
HVAC: X DATA/TELE COMM: NURSE CALLS:
VACUUM SYSTEM: X FIRE ALARM: OUTDOOR LANDSC LITE:
OTHER: ALL ENCOMP : X HVAC: PROTECTIVE SIGNAL:
INSTRUMENTATION: OTHER:
TOTAL # OF SYSTEMS:
Owner: Contractor:
VISTA NORTHWEST INC GARY'S VACUFLO INC
PO BOX 91459 9015 SE FLAVEL
PORTLAND, OR 97291 PORTLAND, OR 97266
Phone: 503 -531 -0505 Phone: 775 -2042
Reg #: MET 00001895
LIC 69047
ELE 26- 728CLE
FEES Required Inspections
Description Date Amount Low Voltage Inspection
[ELPRMT] ELR Permit 9/15/2004 $75.00 Elect'I Final
[TAX] 8% State Surcharl 9/15/2004 $6.00
Total $81.00
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and
all other applicable laws. All work will be done in accordance with approved plans. This permit will expire if work is not
started within 180 days of issuance, or if work is suspended for more than 180 days. ATTENTION: Oregon law requires
you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set forth i 0A s52- 001 -0010
through OAR 952- 01 -0100. You may obtain copies of these rules or direct questions to ! 503) 246 -6699.
Issued by Permittee Signature
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N DATE:
LICENSE NO:
Call 639 -4175 by 7:00 P.M. for an inspection needed the next business day
Electrical Permit ApplicfREC E I V E a FOR OFFICE USE ONLY
City of Tigard SEP 1 21 I 7 � l► Permit No.: e&L "r/O7 — C�Oo a7
13125 SW Hall Blvd., Tigard, OR 97223 Plan Revie Date/By: i
Phone: 503.639.4171 Fax: 503.598.1960 4 '1�'"'r�•,i '•'� Other Permit:
CITY OF TI r . . 1 Date Re
Inspection Line: 503.639.4175 �► ' D ate ReadyBy: fug: ® See Page 2 for Y.
Internet: www.ci.tigard.or.us BUILDING D . ' -- • '' Notified/Method: r Supplemental Information
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t • + � ' r "'4 r �5•,_� �' r.t Y: FI '• OR r , > ww i :- ti; -sa d'_9P, i ✓ P. ,,, ,4'•E''_' {
ew construction ❑ Addition/alteration/replacement Please check all that apply:
['Service over 225 amps, comm'I ❑Hazardous location
El Demolition O ther: Demolition ['Service over 320 amps - rating ❑ Buildng over 10,000 sq. ft.,
4 ' �;' ?'�`-„':. 4! ° "'u rro b rc .y ?,p[p�..�. t � . ,its ,i. -.a: 0^ 5:s .
_,_ s, = F,,.j,,Y.� -.0:4`.1:4-2, . . . i ;c C { AT OR Q ; O It C...._IY11_,x `' , z �,. , � i of 1 -and 2- family dwellings 4 or more new residential
.., 2 family dwelling ❑ Commercial/industrial ❑ Accessory building ❑System over 600 volts nominal units in one structure
❑ Multi family 0 builder ❑ Other: ['Building over three stories ['Feeders, 400 amps or more
� . ,l, i - a r „ , uK ,, �. ; ._ ., . Other: _ ['Occupant load over 99 persons ❑Manufactured structures or
- w .� , . H : 'fib$ � ildRM�� ro1V :6 ��J.00t1�ION• ,;: r ' =�� ❑Egress /lighting RV. park
-� ❑Health -care facility ❑Other:
Job no.: Job site address:
��3 — �/) l "0.09...s. Submit 2 sets of plans with any of the above.
City/ State/ZIP: The above are not applicable to temporary construction service.
Suite/bldg./apt. no,. r ,� :. "- i ". `,�,:�, : 3Sx;� .3':.^,a. ;, -,.,
Project name: ti r:.:zK, ' a �?F �,t?l .?l:'
Description I Qty. I Fee. I Total I
Cross street/directions to job site: New residential single- or multi - family dwelling unit.
Includes attached garage.
1,000 sq. ft. or less 145.15 4
Subdivision Lot no.: Ea. add'1500 sq. ft. or portion _ 33.40 • I
��_ rt/J �� - Limited energy, residential 75.00 2
Tax map /parcel no.:
r T y _ _ Limited energy, non - residential 75.00 • 2
:c:=,,,, _ `.,: _ .. - a ;.11._ .z ,2. °: ., .,. , ::. r:, Each manufactured or modular
- dwelling, service and/or feeder 90.90 2
Services or feeders installation, alteration, and/or relocation
200 amps or less 80.30 2
y...,,,,:„... 3 :. . .' - - - 201 amps to 400 amps 106.85 2
y - "7..)P) '4 9r r
- ❑. T ' ' ' : =�r . •
,. _ ... •' _ � .. - °w : 401 amps to 600 amps 160.60 2
Name: //..,///,37. �G) 601 amps to 1,000 amps 240.60 2
Address:! Over 1,000 amps or volts 454.65 2
�"� �� Reconnect only • 66.85 2
City/State/ZIP: ,--->. / )-" 517 / Temporary services or feeders installation, alteration, and/or
/ relocation
Phone: (52,3 5 - 3/ ._.,..._ 5 ---- . 5- Fax: ( ) 200 amps or less 66.85 1
Owner installation: This installation is being made on property that I own which is not 201 amps to 400 amps 100.30 2
intended for sale, lease, rent, or exchange, according to ORS 447, 449, 670, and 701. 401 amps to 600 amps 133.75 2
Owner signature: Date: Branch circuits - new, alteration, or extension, per panel
4, * �- � /. • " ` - A Fee for branch circuits with
. . ,:if., c �. , I -, • . << `�;.;r. . �x �i:,: n� ' 1]�;C/�lY rt�` C T � 4 ,
� � . "�. �
y - '. �r a . .N r mac„ ' ''.'.`„ �:� <
service or feeder fee, each 6.65 2
Business name: branch circuit
B. Fee for branch circuits
Contact name: without service or feeder fee, 46.85 2
Address: each branch circuit
Each add'I branch circuit 6.65 2
City/State /ZIP: Miscellaneous (service or feeder not included)
Phone: ( ) Fax:: ( ) Pump or irrigation circle 53.40 . 2
Sign or outline lighting 53.40 2
E - mail: Signal circuit(s) or limited -
'� i ,,i ; ; ; ..• , , .' s '. 'h . 'eti J y , • - . °l_ .x' :: : : �i,,,,i;� • i energy panel, alteration, or
- ,c • ��':C r . - �' 1. e : �•� �: '; f, � � L' ;1�OR• • r. `rl? i.�' 1 *- �' �,. w'�'{� ` � '''c- .• a
`' . ,. extension. Describe: Page 2 2
Business name: ,,„et/ ` /' '�� J�
Address: 7 Each additional inspection over allowable in any of the above
Per inspection 62.50
City /State /ZIP: Investigation per hour (1 hr min) 62.50
Phone: ( ) - .4-, Fax: ( ) Industrial plant per hour 73.75 •
; r 7 a =„ �
_:, , r;;: 7-. E a`I.-'iC?1L%::P'E,' f aitrff,igEFSE'i:5 : > . :
CCB Lic.: 4,9 Electrical Lic.: Suprv. Lic.: Subtotal -74
Suprv. Electrician signature, required: Plan review (25% of permit fee)
Print name: Date: State surcharge (8% of permit fee) 6'
TOTAL PERMIT FEE 01
Authorized signature: This permit application expires if a permit is not obtained within 180
days after It has been accepted as complete
Print name: Date: • Fee methodology set by Tri -County Building Industry Service Board
•' NuTber of inspections per permit allowed.
i:\ Building \PermitslELC- PerrnitApp.doc 12/03 440- 46I5T(10 /02/COM/WEB
Electrical Permit Application - City of Tigard -
Page 2 - Supplemental Information
LIMITED ENERGY PERMIT FEES:
Fee for all residential systems combined ... $75.00
Check Type of Work Involved:
❑ Audio and Stereo Systems*
❑ Burglar Alarm
❑ Garage Door Opener*
❑ Heating, Ventilation and Air Conditioning
System*
❑ Vacuum Systems*
❑ Other:
Fee for each commercial system $75.00
(SEE OAR 918- 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
❑ Boiler Controls
❑ Clock Systems
❑ Data Telecommunication Installation
❑ Fire Alarm Installation
❑ HVAC
❑ Instrumentation
❑ Intercom and Paging Systems
❑ Landscape Irrigation Control*
❑ Medical
❑ Nurse Calls •
❑ Outdoor Landscape Lighting*
❑ Protective Signaling
❑ Other
Total number of commercial systems:
*No licenses are required. Licenses are required
for all other installations
i:\ BuildingVennits \ELC•PetntitApp.doc 04/03